Black infants in the U.S. are more than twice as likely to die as white infants. In upper Manhattan, infant mortality rates are four times higher for the minority communities of East and Central Harlem as compared with the predominantly white Upper East Side. This disparity in mortality rates is linked to a greater incidence of prematurity among blacks. Very low birth weight infants (<1500 grams) are 90 times more likely to die than normal birth weight infants, and very low birthweight is 3.5 times more common among blacks than it is among whites. While black infants are much more likely than whites to be born premature, several interventions have been demonstrated to reduce major morbidity and mortality in premature infants. The degree of underuse of these interventions and the relative magnitude of underuse for minority versus white patients has not been well documented. Furthermore, the extent to which white and non-white premature infants receive care at different hospitals in New York City is unknown. Likewise, whether NICUs differ in practice with respect to effective management of prematurity has not been studied. We propose to use medical record review to assess the underuse of three effective interventions (antenatal corticosteroids, surfactant therapy, and maintenance of body temperature) in the management of prematurity. First, we will use birth certificate data to confirm and expand upon preliminary data from hospital discharge abstracts in showing that black premature infants are more likely than white premature infants to be born at low volume hospitals. We will measure underuse of selected effective interventions at two low volume hospitals serving predominantly women from East and Central Harlem and at a high volume hospital serving East and Central Harlem and at a high volume hospital serving East and Central Harlem as well as a diverse population from other areas of New York City. We will assess whether rates of underuse differ by racial and ethnic groups among hospitals serving predominantly minority versus predominantly white communities, and within the one hospital serving a diverse patient population. Finally, we will investigate the likely causes of underuse of effective interventions that preferentially impact the Black and Hispanic communities of East and Central Harlem.